Massive misuse of antibiotics by university students in all regions of China: implications for national policy.

Antimicrobial resistance (AMR) is one of the greatest threats to global health this century. The primary cause of AMR is antibiotic misuse, especially routine use of antibiotics for self-limiting illnesses. This study aimed to explore behaviours related to antibiotic use in university students across China. An electronic questionnaire was distributed at a major university in each of the six regions. A cluster random sampling method was adopted. The χ2 test and logistic regression were used to assess the relationship between knowledge and behaviour. A total of 11,192 students completed the questionnaire. In the past month, 3337 students (29.8%) reported a self-limiting illness, of whom 913 (27.3%) saw a doctor, 600 (65.7%) of whom were prescribed antibiotics [190 (31.7%) by infusion]; 136 students (22.7%) asked for and received antibiotics. Of the 1711 students (51.3%) who treated themselves, 507 (29.6%) self-medicated with antibiotics. In the past year, 23.0% of students had used antibiotics as prophylaxis, 63.1% kept a personal stock of antibiotics and 56.0% had bought antibiotics at a drugstore (two-thirds without a prescription). Students with lower knowledge scores about antibiotics were significantly more likely to see a doctor, be prescribed with antibiotics, self-medicate with antibiotics, and use antibiotics prophylactically. This massive misuse of antibiotics for self-limiting illnesses by well-educated young adults is a serious concern. A national campaign is urgently required to address rational prescribing of antibiotics by doctors, enforce existing restrictions on over-the-counter sale of antibiotics, and educate the general public about antibiotics and the management of self-limiting illnesses.